We identified new barriers to spiritual assessment, including a physician’s upbringing and culture, lack of spiritual inclination or awareness, resistance to exposing personal beliefs, and belief that spiritual discussions will not influence patients’ illnesses or lives. Respondents also postulated patient barriers, including fears that their physician might judge them for their spiritual views or consider their raising spiritual questions inappropriate.
We identified facilitators of spiritual discussions, such as communicating a willingness to have these discussions. One respondent noted that physicians whose lives are characterized by spiritual maturity might serve as agents of patients’ spiritual growth, consistent with a previous study’s themes of caregiver spirituality and physician vocation and mission.14
Limitations
Because qualitative research aims to uncover new perspectives rather than to make generalizable assessments, our findings may not apply to all physicians or to all family physicians. Although our respondents did not represent all major world religions, ethnic groups, and cultures, they did offer a diversity of spiritual and religious perspectives. Finally, our study gives only physicians’ perspectives. We are currently studying patients’ perspectives of situations that elicit spiritual questions and of potential barriers to spiritual assessment. We will use themes from our patient and physician qualitative studies to frame questions for a national patient questionnaire regarding physicians’ spiritual assessment.
Conclusions
Physicians differ in their comfort and practice of addressing spiritual issues with patients, but affirm a role for themselves in responding to patients’ spiritual concerns. Perceived barriers, physicians’ role definition, familiarity with factors likely to prompt spiritual questions, and the recognition of principles guiding spiritual discussions form the context for family physicians’ discussions of spiritual issues with patients. This context is important to consider when training medical students and residents in spiritual assessment. Careful attention to this context will also enhance the practicing physician’s skill in providing patient-centered assistance with spiritual health concerns.
Acknowledgments
The authors wish to acknowledge Arej Sawani, who assisted in data collection; Sheri Price, who assisted in manuscript preparation; and Richard Ellis, MD, MPH, Daniel Vinson, MD, MSPH, Steven Zweig, MD, MSPH, and Dale Smith, who reviewed the manuscript and offered editorial suggestions.